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Menopause

Menopause

October is the National Menopause Awareness Month

To help support patients gain reliable information easily  Dr Rebecca Hayes will be doing a free informal public Q&A on the menopause on Monday 17th October 10.30-11.30 at Tamp Coffee and will also be giving away some free dahlia bouquets to celebrate the national awareness campaign.

What is the menopause?

All women go through various stages of hormone production in life, you are born with a fixed number of eggs in your ovaries which gradually decrease over time. Usually from around the age of 45, the number of eggs has started to decline to a level that you might get lower amounts of oestrogen and progesterone and might start to have some symptoms though some women don’t get any symptoms.

Menopause is when your periods stop and you are post-menopausal once your periods have stopped for 12 months or more. Before this time you are in the peri-menopause or I prefer the term “Menopause transition”. Premature menopause is before the age of 40. Early Menopause is before the age of 45.

What are the symptoms?

These can be hugely variable from person to person.

They range from not having any bothersome symptoms to brain fog, reduced concentration, insomnia, hot flushes, vaginal dryness, low mood, irritability and low libido as well as joint aches and pain. I generally like to complete the Green Climeric Score on my patients to help work out where to focus on symptom control.

Click to view an Example Score Sheet.

Do I need blood tests?

This really depends on your age, symptoms and what medication you are taking. For most women, we don’t need to take a blood test to confirm the menopause transition. Blood tests are helpful to rule out other causes or as a response to HRT to check if you are absorbing the correct dose.

If you have been on HRT for 6 weeks or more and have not had a good response then it is worth considering discussing checking various hormone levels with your GP. Usually, most women have good symptom control with oestrogen levels in the 200-400 range.

However, we sometimes need to achieve higher levels with psychological symptoms but this will depend on various factors and your overall health so it is a tailored personalised approach. If symptoms such as libido have not improved on adequate oestrogen therapy then testosterone deficiency can be screened with a Free Androgen Index.

 

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Should I start HRT?

This is a very personalised decision as there are many options and different types of HRT and will depend on your medical history and current circumstances and contraception needs. You might find the HRT you start in your 40’s changes and doesn’t suit you later so it might also be a changing process over time. This is why a personalised approach is best.

There are now newer safer types of HRT available such as transdermal oestrogen ie oestrogen through the skin. This is much safer than the older oral tablets. This can be administered as a gel, spray or patch. There are different doses depending on your needs and different brands to suit your skin.

Progesterone is needed if you still have a womb and the body identical progesterone tablet Utrogestan is the safest licenced in England at the moment. This is usually taken at night as it is sedating and depending on if you still have periods or not will depend on your dose and frequency.

Sometimes women also need testosterone if they have ongoing symptoms not controlled by oestrogen and this is checked with a Free Androgen Index. Testosterone is replaced with a gel and will need blood test monitoring every 3-6 months.

Risks of HRT

Over the recent years, the risks of HRT have mainly been blown out of proportion and for most women, the benefits outweigh any risks. An individualised approach is needed according to your own risk factors. For women who need HRT under the age of 50, there is no increased risk of taking HRT until the average age of menopause at 50. The risks of HRT are really associated with women over the age of 50 however these need to be put into context of your symptoms, quality of life and other risk factors. There is good further information on https://www.womens-health-concern.org/help-and-advice/factsheets/hrt/

If you would like to find out more about Menopause – head down to Dr Hayes’ first-ever Free Menopause Awareness Talk at Tamp Coffee or if you would like to take a more in-depth look at your Menopause symptoms you can enquire about a Specialist Consultation at Prime Health Partners.

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